2010 TRACK LICENSE & REGISTRATION
ALGONA RACEWAY ~ FAIRMONT RACEWAY ~ I-35 SPEEDWAY
P.O. BOX 659, ALGONA, IA 50511

DATE OF BIRTH_____________________          JACKET SIZE_____________________
   
HOME PHONE # _________________      CELL #______________                                       
                                             

CAR OWNER________________________________
1099 to driver?  ____________ If not –payee name _________________________________

PAYEE SOCIAL SECURITY #________________________ MUST BE FILLED OUT OR DRIVER WILL RECEIVE 1099

PAYEE ADDRESS______________________ CITY______________ STATE_______ZIP_____________

 AGREEMENT

CONTRACT:  I hereby certify that I am an independent contractor.  Assuming all responsibility for money received as a result of my activities at the Raceway, including without eliminating, income taxes, FICA, workman’s compensation.  I am not an employee, servant or agent of the Raceway.
CONSIDERATION & COMPLIANCE:  In consideration of acceptance by the Raceway of this application and payment of registration & license fees the undersigned agrees to abide by all the rules and regulation of the Raceway as to conduct and mechanical applications as now published or hereafter modified.  The undersigned further recognizes his obligation to the public and to the Raceway, which posts the prize monies and conducts the events and agrees to compete in all events for which he may be qualified. We reserve the right to refuse anyone due to slander, libel, defamation, etc.
BREACH & DAMAGE:  In the event the undersigned breaches this agreement, he shall be liable for actual and liquidated damages sustained by the Raceway as a direct or indirect result of such breach.
BENEFITS: I understand and agree that myself and my executors and assigns will be entitled to the benefits of the Competitor Accident Insurance Policy procured by the Raceway for accidental death or injuries which occur as the result of external, violent and visible means sustained in Raceway events.  The coverage of said policy shall constitute the limit of liability of the Raceway for such injuries occurring to me an any Raceway event, provided proper notification of such occurrence is filed with the Raceway.
ADVERTISING RELEASE:  The undersigned consents to the use of his name and/or pictures of himself and his car for publicity, advertising and endorsements, both before and after events, and relinquished any rights to photos taken in connection with events, and consents to the publication or sale of such photos by the Raceway.  This includes any video or delayed transmission of images.
ARBITRATION:  Any dispute, controversy or claim involving the undersigned, whether or not relating to this agreement of same, shall be settled in accordance with existing and/or amended rules and regulation of the Raceway, and the undersigned agrees to accept the decision rendered by such process.
BY MY SIGNATURE BELOW, I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THIS AGREEMENT.
I AGREE TO ABIDE BY ALL TERMS OF THIS AGREEMENT AND THE RULES OF THE RACEWAY.

SIGNATURE_________________________________________________              DATE_______________